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tv   [untitled]    March 21, 2012 1:30pm-2:00pm EDT

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forth, and we've built those assumptions into our budget. >> as you may remember, that reform provided at that time funds to help in work force training so. my question is do you assume since you make work force training a condition of receiving food stamps, how much do you assume will be provided in that training. >> food stamps has gone through a huge growth in the past, i think it's quadrupled over the a period of time. enormous growth. there are a number of legislative pantions. ultimately just in the case with other programs where we've given states greater flexibility it would be their responsibility to figure out how to allocate the funds and deal with these
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issues. >> i'm just -- i don't want to get in an argument. i'm trying to get an answer. as i understand what you're saying this budget does not provide those states with any funds to provide the job training that would be required as a condition of receiving food stamps. is that correct? >> within food stamps would be addressed by virtue of the -- through the block grant. the federal government has a host of other job training programs, i think 49 of them across several agencies. there's another reform in the chairman's mark to consolidate those programs to better target get better results. >> that's the point i wanted to get into which is the answer is you have the block grant and the work requirement or the job training requirement, another provision of the budget we propose to consolidate the 49 different various federal job
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training programs into a -- we have a job training proposal, in another part of the budget to streamline work federal job training programs to go to individuals for career scholarship so there is a job training program in this budget, let's also not forget the fact as a result of the 1990s welfare reform new job training programs were begun in those days as well which are still in place. >> thank you. >> give you a break for a second. i did want to ask one other question on health care. that was one of the aspects of the budget is a fairly dramatic cut in medicaid. this has been explained as a flexibility to our governors, to our states, and being able to do things differently under medicaid. states now have quite a bit of
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flexibility. they set the rates of reimbursement. some of those are too low, made it very difficult. but the cuts in this budget as i understand basically start at 30% and go up from there. to maybe almost 70, 75% over time. you may want to correct me on that. i understand it's $800 billion, about a third is the numbers we have. if we're misreading that that would be a good thing. >> no. we don't make a 30% immediate reduction in medicaid. over the 10-year period -- medicaid first is seeing very rapid growth in the base program. on top of that there is a large expansion under the affordable care act. i believe the block grant savings are $810 billion. >> which is what percent? >> in terms of the percentage we can go back and find that out. >> maybe it gross to 30% so i just understand some of this is
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cutting the as you call it expansion from the affordable care act. one of my questions for you is what standards or is there anything in the budget that would suggest that we're going to hold states and governors accountable for providing the services under medicaid? many of us are worried about women and children, but also as you know the big costs are in nursing homes and frail sick seniors. is there any way that there is something in the budget that holds states accountable for continuing to provide support for seniors in nursing homes, very frail or elderly or disabled or is that up to the governors? >> so our assumption is that states would still be required to spend their medicaid allotment on their medicaid eligible population, we don't go into that level specificity in the budget. that's the assumption.
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on the medicare side, too, you'll see over the long term though the medicaid numbers going down, medicaid numbers growing in part because the medicare reform assumes the double eligible population. we have an additional low income supplement give tune the medicaid eligibles and those above the medicaid eligibility. >> do you have some definition about that. i read that is the assumption. we heard it sort of, dual eligibles. could you provide how the assumptions you're making how that would be handled because that is something that's fairly new for us. >> we can provide additional information. >> that would be fine. there are some questions later on the assumptions about whether the states would have adequate resources to be able to do what they are doing now for frail, elderly in our nursing homes under medicaid given the reductions that are being made
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in this budget. i yield back. >> this is a budget resolution so it's not the final legislation. that's what the authorizing committees are in charge of doing, so the budget resolution contains certain assumptions. it also assumes assumptions that medicaid money goes to the medicaid population. a governor can't take it and use it for roads or something like that. but that level of specificivity rests with the committee. so it's important so you know that in a budget resolution you don't have that level of detail. but that's what the authorizers end up doing. >> this is between women and children, it's a broad category, seniors, they can provide a variety of services there. there is no way of knowing at this point in the budget about the detail coming later about how this money might be used and affect our frailest and sickest. >> the assumption it must go for its intended population. >> mr. chairman, may i comment as well. is that possible?
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i want to point out that the medicaid system right now makes its such that we spend a lot of money that is wasted on folks who are by and large healthy. right now in the state of georgia, two thirds of the folks on -- medicaid rolls -- was that -- >> yeah. we'll do this, i think there's medicaid and medicare amendments so. why don't we get into this conversation, then this is a staff walk-through and stick within the lanes of the procedure or we're going to have a real long day. >> thank you, mr. chairman. let me turn to education, training and employment function 500. where it's cut. that function is cut by 166 billion below the line over the 10-year period. how much of that is from the student aid programs? >> again we have assumptions in
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terms of what happens on these programs, ultimately determined by the authorizing committees with respect to the mandatory programs in education, there were expansions done in some bills, one of them was a reconciliation bill, expansions that were done for income-based repayment program. we assume that expansion would be reversed. there are other assumptions on the mandatory side we make. >> you have assumptions regarding pell grants? >> we assume -- we do not assume an increase in the maximum award. we assume the current award level, the president's budget has a higher award level, but his budget doesn't sustain funding for that. he only funds it for two years so our assumption on pell grants is it be funded within the discretionary amount.
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we assume that pell grants is funded as a discretionary program. it's got this bifurcated treatment now, and portions funded with discretionary funds. we assume that the program's funded with discretionary resources and that the maximum award is maintained. >> that's a significant portion of that 166 is the shift from mandatory to discretionary. >> do you assume the doubling of the stafford loan interest rates that are coming out? >> we make no change with respect to the assumption in the baseline. that's under current law. >> let me turn to the function 920, allowances. your budget shows for each of the functions, sort of certain spending, i assume they are targets for the different areas. defense, international affairs, education, then you've got $900
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billion in your allowances function. could you explain what that represents. >> there are a couple of things going on. the first is that cbo with respect to the sequester savings puts the savings in function 920, in addition, we focus on discretionary program, 2013 in what's going on in our assumptions. we carry some of those assumptions into the out years but will be revisited through the appropriations process. so we didn't spend a great deal of time on going through individually what are the specific assumptions through the next ten years in discretionary programs. that will be determined by the appropriations committee. the other thing is when you look at the president's budget, he carries all of his out year savings, all, in an allowance,
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unspecified allowance. we've gone through and specified a fair amount of savings, but we haven't listed them all. within 920 we have specific proposals that cut across the government. couple examples are in attrition, in the federal work force we have savings. the cbo baseline has disaster funding that was enacted last year. we moved that, there are a couple of other areas as well. >> just so i understand, those allowances, $900 billion in cuts which is an unusual amount of money in that category, so the proposaters could cut defense or by any amount up to that is that right? >> our overall discretionary levels, the budget control act
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levels, under the -- after the joint committee beyond 2013 we assume total discretionary spending at those levels. our defense spending is frozen at this year's level which is higher than the president's budget this year, then we have a real growth in the defense budget. we do not assume reductions in the defense budget in the outyears. we assume those savings are achieved in non-defense programs. >> if i could for clarification. you're showing in your function tables as you go out for 10 years, you are showing a certain level of spending but you're also showing levels of spending in the other functions. >> yes. >> you have this allowance at the end, $900 billion. is there anything in your budget that says that defense spending would remain at the same level in all of those functions any more than any other function?
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>> if you look at the baseline, it has very, very large savings already. that was our starting point in terms of marking up a budget. i think our additional savings are on the order of $200 billion. we did assume specific savings that are difficult to distribute in the individual functions from attrition in the federal work force. i believe the pay freeze we have those savition in function 920. there are sf unspecified savings. they are not as large as the $900 billion that you cite. >> i gather that tappropriators including defense. >> 3 are always free to do that. we can't bind how the committee appropriates funds. >> we could create a fire wall. >> we do not create a fire wall. >> so my last set of questions
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mr. chairman, last one. though then with your own indulgence we have minor ones we think hopefully the staff can answer in more detail. with respect to the overall discretionary cap for this year in your budget, which of course there has been much discussion about, as you know mr. chairman, we believe that there was a level set in place, in fact it was put in place and signed by the president, one of our budget reform processes was to do that so that it would be predictable. apparently that's not predictable in this case. but i want to know what exactly is the discretionary spending cap in this proposed budget? >> i think it might be useful to start and describe how the budget control act works.
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the cap you're correct, the cap that was established for fiscal year 2013 was 1 trillion 47 billion dollars. the joint select committee was assigned to achieve savings. if it didn't achieve savings which it did not, that cap is going to be reduced to $950 billion on january 2, 2013. so there are really two caps. there's 1047, 1 trillion 47. to answer your question our assumed level we would set for the committee in this resolution, 1 trillion 28 billion. >> thank you, mr. chairman. >> now it is 1:45. we have a half hour before the vote series, i believe. so let's proceed to amendments.
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yes. >> i referenced an article -- >> without objection. absolutely. sure. >> i provided staff. >> sounds good. we'll proceed with consideration of the fiscal year 2013 current kes loo resolution. under rule -- sorry. wrong page. under committee rule 9 t committee will consider a document containing the budget function and other matters, amendments, amendments may be offered to this document subject to this agreement between the majority and the minority, after this document has been approved it will be incorporated in the text of the resolution for the final vote and whether to report the measure to the house. the committee will now proceed with other matters. the ranking member and i have agreed to limit the time for consideration of each amendment. now we proceed to the amendment process. the committee, the ranking member and i agreed to limit
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time for the consideration of each amendment so that there will be ample opportunity for all members to offer amendments, a list has been distributed. they are in three tiers. this should be familiar to most people. as part of this agreement the time will be limited to 20 minutes. tier two, to 15 minutes and tier three limited to ten minutes. debate time will be evenly divided between the sponsor and the member opposed. the proponent of the amendment will have one minute to close. 9, 10, back to one. for example in tier one. the document will be considered as read and open to amendment at any point. >> since we may have votes during the day seek consent to give the chair into recess. >> the gentleman asked for unanimous consent. without objection agreed to. >> are there amendments?
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miss schwartz, i think you're first up. >> thank you. yes. i do have an amendment and -- >> the clerk will designate the amendment. the staff will distribute. >> amendment offered by miss schwartz, relating to medicare. >> miss schwartz. >> yes. i think i would be more explicit to say it's an amendment that would prevent the budget to end medicare as we know it. and i would want to just begin and then a couple of others that want to speak to. for decades medicare has been a life line for older americans providing quality and affordable health coverage for all seniors in our country. the creation medicare in 1965 addressed the fundamental challenge of aging seniors as health care costs increase and incomes decline. prior to medicare little over a half of those over 65 had insurance and private insurers were terminating coverage to those in greatest need of care.
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medicare is a promise to our seniors that they will not be left alone to manage the burden of health care costs in the vulnerable years. house republicans are now again proposing to break that promise. the republican medicare voucher plan ends medicare guarantees of a specific set of health benefits to our seniors. it ends the wide array of choices currently available under medicare from ttin which physicians participate, as providers, to medicare advantage, a new innovative delivery models. the voucher offered by republicans not only is limited in amount, thereby limiting choices that seniors will have depending on their ability to pay, but will also make no guarantee that they can keep their current benefits or their own doctor. this year's republican plan just like last year's proposal, not only eliminates guaranteed benefits and shifts costs to
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beneficiaries, but does nothing to address the underlying causes of growing health care costs. so as costs rise, it's seniors alone who will bear the financial burden in the future. as we just heard in some of the questions, that's absolutely clear. last year's republican budget would have increased health care costs for the typical 65-year-old by more than $6,000. in 2022. yet knowing that, they proposed the very same agenda again. there is a better way to confront the challenge of growing health care costs for seniors and for all americans. thanks to the law that we put in place, the -- and the republicans repeal under this budget, we are moving from a highly fragmented health services to innovative payment delivery models that improve quality while reducing costs. the patient-center the medical homes, care organizations, payments, fewer readmissions to
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hospitals better transitions of care and improved care coordination for those with chronic diseases, billions of dollars will be saved for seniors and for taxpayers. this republican budget walks away from health care savings in the affordable care act. it protects seniors access to care and reduces our nation's deficit. their budget weakens medicare and reverses the potential transformation of health care service delivery and reduced costs for seniors. this republican budget walks away from coverage from prevention, primary care, prescription drug coverage and it costs our current seniors as well as future seniors. this republican budget walkways from our seniors, newsing ho nu. every day seniors can count on medicare for life-saving medications doctors' visits, and
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denying this health care by privatizing medicare is not responsible budgeting. it's a betrayal of our nation's seniors and democrats in this administration will not let it happen. i would like to yield back. yield to my good friend and ranking member. >> thank you, ms. schwartz and thank you for offering this amendment. as this committee knows very well, the increase in costs for beneficiary in the private market have been going up at least as fast in most years faster than the increase of costs in the medicare program. we also know by looking at medicare advantage itself, that until the past affordable care act, we were paying 140% in many cases of fee for service. let me say that again. we were providing the private plans with a huge subsidy, paid not only by taxpayers but by
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every medicare beneficiary in the fee for service program. so to suggest this as a solution is counter to facts.-- and it's pretty clear from the structure of this proposal, that in the end of the day you realize we can't rely on the market, because unlike the federal employee health benefit plan, unlike medicare part d prescription drug which republicans say is the model, in this case, in this case, you are capping the amount of the voucher of the premium support whatever you want to call it regardless of the increase in health care costs. and when you do that, when you do that, you are transferring the costs and risk s of rising health care costs to the seniors. who are going to have to pay a lot more. that's why cbo did its analysis last year based on the other assumptions. now, there are different parameters here, but, again, the consequences are the same, and
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as mr. smythe just told us in response to the questions, the reality is, if those costs rise at a rate that's faster than gdp plus .5, seniors will be left holding the bag with respect to the amount they get with the voucher and you know what? if they can't find a plan with current benefits, with that voucher, they're going to have to take less benefits. or if they find a plan with current benefits it may cost a whole lot more. and reality is, in our view, that's a violation of the medicare guarantee, because everybody should always be able to be assured of the existing benefits without having to pay a whole lot more. so with that, ms. schwartz thank
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you for the opportunity. >> this is moving forward and protects guaranteed benefits, and avoids a cost shift to seniors, in this country. it's something that has worked for a long time. we need to contain the rate of growth of costs in the right way and protect other soviet unioniers and i would like to reserve the balance of my time, i think to close. just one minute. well, when we be happy to -- >> now, but you'll get -- >> got it. >> at the end. >> you're saving one for me already? >> yes. >> then i would be happy to just add one other comment, if i may, just received, hot out of the wires aarp has just sent us all a letter that does talk to the fact that -- >> no, no. i'm sorry. was my mike on? yes. all right. please, continue. i apologize. >> thank you. >> i would like to just say that they do, have sent us something i would like to quote, that the house republican budget
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proposal, while -- lacks balance jeopardizes the health and security of older americans and puts at risk the bipartisan agreement on discretionary spending levels. i think that is a, medicare is something that is important to all of our seniors and their families and the fact that this budget puts a great risk on that guarantee and promise to americans, and we should be working together to make sure that we save money in the right way, not jeopardize our sickest seniors or in fact some of our healthier seniors as well. any senior in this country, actually, any american, could be bankrupt by the cost of health coverage. i yield back. sorry. i want to yield one minute if i may. >> 37 seconds. >> i'm sorry. i didn't see you get here. >> we have -- we had substantial progress in trying to address the problems with medicare and rising health care costs last year when we, year before last,
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actually, when we added 12 years to the solvency of medicare thr through the affordable health care act. it is a real mistake to fundamentally change medicare in a way that asks more from those who have the least when the same budget simply helps more those who have the most. and i believe that the approach that the gentlewoman takes is the right one. >> gentleman's time is expired. ten minutes back for our side. >> thank you. >> no problem. i will -- i promise i'm not going to claim time on everyone one of the moments but on this one i'm going to. i'd like to debunk the entire political attacks on the republican effort to save medicare. first, we keep hearing voi invo an interchangeable word. a voucher is like going to the
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mailbox and getting a check in the mail and then taking that check and going and doing something with it. buying insurance, school tuition for your kids or something like that. that's not what premium support it. actually all of us should know what it is because it's what we have as federal employees. a list of guaranteed coverage options that are pre-selected in this case by medicare in a medicare exchange. in this case, you can't be denied care base onds health standards. you're guaranteed issue. community rating. you pick that plan, and then medicare subsidizes your premium. they subsidize your premium based on who you are. less if you're a wealthy person. full total coverage if you're low income and more coverage as you get sicker. review a stunning chart base and medicare, you no e i'm not going to yield. >> one question. >> no. review a chart on medicare's future under the president's
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approach and the house republican approach. start with the republican budget. let's look at how this budget puts medicare spending on a sustainable path. may i click? yep. my battery's working now on this. this shows you the growth rate of medicare under the republican budget over the long term. this shows you how we can do a plan where there are no changes for people in and near retirement. and how we have more choices for people in the future, 54-year-olds and below. this year's budget, it's a fact that people don't like to hear on the other side, but it also guarantees the traditional fee for service plan exists forever. these are guaranteed coverage options. now, the gentleman talks about a cap. the cbo themselves tell us they don't know how to measure competitive bidding. therefore, a i


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